92 Decision Citation: BVA 92-27716
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 92-04 341 ) DATE
)
)
)
THE ISSUES
1. Entitlement to an increased evaluation for chronic
nephritis with hypertension, currently rated as 30 percent
disabling.
2. Entitlement to an increased evaluation for residuals of
a gunshot wound to the right thigh with damage to Muscle
Group XIV, currently rated as 10 percent disabling.
3. Entitlement to an increased evaluation for residuals of
a burn to the left hand, currently rated as 10 percent
disabling.
4. Entitlement to an increased (compensable) evaluation for
a scar of the left thigh.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
T. H. Smith, Counsel
INTRODUCTION
This matter came before the Board of Veterans Appeals
(hereinafter the Board or BVA) on appeal from an October
1991 rating decision of the Reno, Nevada, regional office
(hereinafter RO). That decision confirmed and continued a
30 percent rating in effect for chronic nephritis with
hypertension, a 10 percent rating for residuals of a gunshot
wound to the right thigh, a 10 percent rating for residuals
of a burn to the left hand, and a noncompensable rating for
a left thigh scar. The notice of disagreement was received
on November 1, 1991, and the statement of the case was
issued on November 19, 1991. The substantive appeal was
received on March 4, 1992.
The appeal was received at the Board on April 6, 1992, and
was docketed on April 9, 1992. The appellant is represented
on appeal by the service organization, Disabled American
Veterans, which submitted additional written argument on
July 16, 1992.
The veteran had active service from June 1950 to June 1953
and February 5, 1954, to March 23, 1954.
REMAND
The veteran asserts that the RO committed error in
confirming and continuing the disability ratings as
reflected on the title page of this decision. He argues
that each of these service-connected disabilities warrant
increased ratings. Specifically, he reports that his blood
pressure is elevated, and he experiences constant left hand
pain and occasional right leg problems.
A review of the evidence of record shows that service
connection was established for these disorders by rating
decision in 1954. A 30 percent rating for nephritis with
hypertension, a 10 percent rating for residuals of a gunshot
wound, and a 10 percent rating for residuals of a left hand
burn have been in effect since March 1954. A noncompensable
rating has been in effect for the left thigh scar since June
1953.
Of record are Department of Veterans Affairs (VA)
examination reports from July 1991. The orthopedic examiner
noted that there was contracture of the fingers of the left
hand with some skin thickening. Specifically, there was
distal interphalangeal (DIP) contracture "in the fifth
finger 45 degrees with flexion beyond that normal."
Proximal interphalangeal (PIP) and metaocarpophalangeal (MP)
were normal. It was noted that ring finger "PIP flexion
contracture 40 with flexion beyond that normal." The
physician also reported that "DIP 10 with flexion beyond
that normal." The middle finger had a PIP flexion of 5 with
flexion beyond that being normal. The DIP had a fixed
flexion of 30 with flexion beyond that being normal. The
index finger had "10 through normal flexion and DIP [was] 30
through normal." The veteran had Dupuytren's thickening in
both palms and the pre-tendinous band. The examiner's
impressions included status post burn scars in the left hand
and stationary thigh wounds scars. The scar on the right
thigh was described as posterior in the medial hamstring
without any significant findings. There was no loss of
motion. The physician opined that if the hand contractures
worsened, surgical intervention might be called for some
time in the future.
The nephrology examination report from July 1991 shows blood
pressure readings of 140/92 and 142/94. Final diagnoses
included systemic arterial hypertension, fairly well
controlled. Inflammation of the kidney was not indicated
and chest examination was negative. Micro-albuminemia,
secondary to hypertension was diagnosed. According to the
examiner, additional diagnostic or therapeutic maneuvers
were not required at the present time because this
proteinuria was less than 1 gram. He added, however, that
if the proteinuria continued, or if there was any diminution
in renal function or worsening of the hypertension,
consideration should be given to serological evaluation and
possible renal biopsy.
The veteran submitted a statement in March 1992 in which he
argued that July 1991 lab abnormalities concerning his
nephritis had not been addressed. He stated that he
experienced problems in both thighs, particularly on the
right side. He said that his thigh was not examined at the
recent evaluation. He also said that his left hand
condition was worse. It hurt when he "hit something" and it
bled easily.
Representatives of the service organization, Disabled
American Veterans, provided statements in March 1992 and
July 1992 in support of the veteran's claims. It was
contended that additional development was necessary. One
representative asserted that it was now "almost impossible"
for the veteran to utilize his left hand. They asserted
that additional clinical findings should be accomplished
concerning the veteran's nephritis and hypertension. It was
argued that the recent examination did not include an
adequate number of blood pressure readings. Thus, the
examination was not in compliance with the Physician's Guide
for Disability Evaluation Examinations.
The Department of Veterans Affairs (VA) has a duty to assist
the veteran in the development of facts pertinent to his
claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §
3.103(a) (1991). The United States Court of Veterans
Appeals has held that the duty to assist the veteran in
obtaining and developing available facts and evidence to
support his claim includes obtaining adequate VA
examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990).
In view of the foregoing, it is our determination that
additional development is necessary. Accordingly, in order
to obtain clarifying medical data, the Board will REMAND the
case for the following development:
The appellant should be provided special
VA nephrology, cardiovascular system, and
surgical examinations to be performed by
appropriate specialists. These
examinations are for the purpose of
identifying and describing the extent of
the veteran's nephritis with hypertension,
residuals of gunshot wound to the right
thigh, burn scars of the left hand, and
left thigh scar. Each of these
examinations should be conducted in
accordance with pertinent criteria and
procedures set forth in the Physician's
Guide for Disability Evaluation
Examinations. The claims folder should be
made available to the examiners and all
indicated testing should be performed.
Upon completion of the foregoing, if the benefits sought are not
granted, a supplemental statement of the case should be
furnished to the appellant. After he has been provided an
opportunity to respond, the claims folder should be returned to
the Board for further appellate consideration, if in order. No
action is required by the veteran until further notice.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
C. P. RUSSELL
JACK W. BLASINGAME
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of the
Board, to proceed with the transaction of business without
awaiting assignment of an additional Member to the Section when
the Section is composed of fewer than three Members due to
absence of a Member, vacancy on the Board or inability of the
Member assigned to the Section to serve on the panel. The
Chairman has directed that the Section proceed with this
decision without awaiting the assignment of a third Member.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal.